Experience of Care: Healthcare’s 3-Point Line

Anybody watch basketball last week? I am not a big fan of the NBA, and let’s face it, the recent NCAA men’s basketball final was a tough act to follow, but there were two remarkable NBA games on the West coast last Wednesday night. Kobe Bryant, playing in what he told us would be his last game, racked up 60 points (including the game winner). A remarkable performance even if it required Kobe to jack up 50 shots. Just up the coast, however, an even more impressive event was underway. The Golden State Warriors broke a decades-old record, finishing the NBA season with a 73-9 record. After winning the championship last year, they started this season with 24 consecutive wins, another record. Their best player, and arguably the best guy playing the game today, scored 46 points including 10 3-point shots last Wednesday. Significance? Steph Curry finishes the regular season as the league’s leading scorer, averaging just over 30 points per game. He made over half of the shots he took this year, over 45% of his three point shots, and over 90% of his free throws. If those figures are not enough to grab your attention, consider this: Curry made 402 3-point shots this season, annihilating the record of 286, which he set last year. As noted in the Wall Street Journal, Curry’s prowess from distance extends well beyond the 3-point line.

Game changer

How is it that a guy who stands 6’ 3” tall and weighs 185 pounds (a short, skinny guy by NBA standards) is about to win his second consecutive league Most Valuable Player of the year award? Many would point to a change in the rules of the game—the introduction of the 3-point shot in 1980 (about 8 years before Curry was born).

Is there a 3-point line in nephrology? Admittedly it’s a stretch, but let’s explore a growing facet of what we might describe as “consumerism”.

Public reporting

A couple pieces of legislation you are familiar with have paved the way for public reporting about physicians. Much has been written about physician receipts from Medicare claims data making its way into the public domain. In addition, the Sunshine Act is shining a light (OK, I couldn’t resist) on the payment physicians collect from health care companies, like those in the pharma space. But what I’d like to draw your attention to is quality and experience of care reporting.

Physician Compare is a byproduct of the Affordable Care Act (ACA). The ACA compelled Health and Human Services (HHS) to create a mechanism that permits Medicare beneficiaries to make more “informed” decisions when selecting a health care provider. Never accused of recreating the wheel, HHS launched another Compare website, joining the expanding stable of Compare websites, which today includes Hospital, Nursing Home, Dialysis, and Home Health Compare.

Of course, anyone who has tried to use these websites recognizes what a disaster they are. While navigation has improved over the years, some would say you need a medical license simply to understand what’s being measured. Of course once you understand what’s there, you realize much of what’s measured is not what drives a patient’s health care choices.

Experience of care

Enter the 3-point line of public reporting. As opposed to trolling the internet looking for “objective” data like the data published on the CMS Compare websites, patients are increasingly visiting websites where other patients are self-reporting their personal health care experiences. Of note, this type of reporting is largely about the patient’s experience of care. Writing in Health Affairs this month, Steven Findlay notes, “Most consumers focus primarily on the service components of care and their relationship with health professionals, not the care itself, or the outcomes of that care.”¹ Findlay reports that sites like Healthgrades, Consumer Reports, and ProPublica see millions of visitors every year. In fact Healthgrades reported almost 9-million visitors in a single month!¹

CAHPS

Not to be confused with patient satisfaction, experience of care is a broad topic and one that CMS has been chasing for more than a decade. CMS now delivers a series of Consumer Assessment of Healthcare Provider and Systems (CAHPS) surveys. The In-Center Hemodialysis (ICH CAHPS) survey has been administered to Medicare beneficiaries for several years now. Among the 60 questions within the survey are 7 questions laser-focused on the patient’s “kidney doctor”. Did your kidney doctor listen carefully to you? Explain things in a way that was easy for you to understand? Show respect for what you had to say? Spend enough time with you? How often did you feel your kidney doctors really cared about you as a person? And perhaps my favorite: Using any number from 0 to 10, where 0 is the worst kidney doctors possible and 10 is the best kidney doctors possible, what number would you use to rate the kidney doctors you have now?

MACRA

Granted it has been a few years, but delivering or improving a patient’s experience of care was not a primary focus of my medical training, and I doubt it was part of yours. And yet, patient experience of care along with patient-reported outcomes are increasingly important components of the quality measurements we are being held accountable for. Later this year we will learn more about the implementation of MACRA. Some believe that as part of the MACRA implementation, the Meaningful Use program as we know it is finished. Regardless of what becomes of the MU program, one thing you can count on is the growing importance of our patients’ self-reported experience of care. Like the 3-point line, this is a “rule change” that could have a substantial impact on the practice of nephrology. How will we respond? Hopefully like that short, skinny kid out West…nothing but net.

¹ Findlay SD. Consumers Interest in Provider Ratings Grows, and Improved Report Cards and Other Steps Could Accelerate Their Use. Health Aff (Millwood). 2016;35(4);688-696.

Terry Ketchersid, MD, MBA, practiced nephrology for 15 years before spending the past seven years at Acumen focused on the Health IT needs of nephrologists. He currently holds the position of Chief Medical Officer for the Integrated Care Group at Fresenius Medical Care North America where he leverages his passion for Health IT to problem solve the coordination of care for the complex patient population served by the enterprise.